When Greg and Sugar Bull were ready to start a family, health challenges required them to work with a pregnant surrogate mother. The woman who gave birth to twins lived in two states.
Pregnancy went smoothly until the surrogate experienced high blood pressure and other symptoms of pre-eclampsia, which could harm her and her baby. The doctor ordered an emergency delivery at 34 weeks gestation. Both babies had to spend at least a week in the neonatal intensive care unit.
It was the early April 2020 of the pandemic. The Bulls couldn’t fly and drove from his home in Huntington Beach, California to a hospital in Provo, Utah. They had to be quarantined in Utah before they could see the children in the hospital.
A few weeks later, after the babies were able to eat and breathe on their own, the Bulls took them back to California.
Then came the bill.
patient: Newborn twins subject to Cigna’s policy sponsored by Scarlet, Redford Bull, and Greg Bull’s employer. Her pregnancy surrogate had her own insurance, which covered her care.
Medical services: Intensive care for newborns when the baby is born prematurely after an emergency induced delivery. Scarlet spent 16 days in the NICU. Redford, 10.
Total billing amount: $ 117,084. The hospital was out of the baby network. Signa paid part of Scarlet’s care for reasons the Bulls couldn’t understand. The Bulls were left on the hook for about $ 80,000 for both babies. Their account was finally sent to the collection.
Service provider: Utah Valley Hospital in Provo, Utah is one of the 24 hospitals operated by Intermountain Healthcare and is a non-profit organization with revenues of approximately $ 8 billion.
What to give: The Bulls Trial points to loopholes in the scope of emergency care, even under the No Surprise Act, which came into force on January 1 and outlawed many types of surprising medical costs.
Patients in need of rapid and life-saving treatment often do not have time to find a hospital in their network. In the past, medical plans sometimes said that you would pay for emergency care even if you weren’t connected to the network. Currently, the No Surprise Act makes this a legal requirement in all states. Health providers and insurance companies are supposed to remove patients from the equation and negotiate reasonable payments.
But what if the insurance company denies that care is for an emergency? Or does the hospital provide documents to prove it?
That’s what happened to the Bulls. Cigna said there was a lack of documentation that the NICU was taking care of the twins identified as an emergency.
So the Bulls began to be insured about the enormous balance owed to Utah Valley. The family expected to borrow up to $ 10,000 out of the network and at their own expense to care for the twins. They assumed that most of the invoices would soon be paid by CIGNA. They weren’t.
“I had no way of making this a reality,” said interior designer Sugar Bull.
“Dear Scarlett Bull” started one of Cigna’s letters to a 6-month-old baby. “It turns out that the requested service is not medically necessary.”
Why is NICU Care disqualified? Resolve Medical Bills, a consultancy that eventually worked with Bulls to resolve the claim, said Cigna initially concluded that there was no emergency because the pregnant surrogate was admitted to obstetrics by a doctor without going through the emergency department. Said Dylan Kirksey.
To prove that it was, Cigna sought daily progress records and other medical records for the baby. The Bulls tried to get him to follow the hospital. Cigna continued to say she had not received the required documents.
The Bulls have appealed. Sugar spent hours on insurance paperwork and music retention. But almost a year later, there were about $ 80,000 invoices left. Utah Valley sent the account to the collection, Sugar Bull said. It was the last time she spent her time.
“I was running a company and I was very busy and had twins,” she said. “Every two weeks or so, I’ll feel panic and legitimate anger about it, and I keep pushing and calling, which takes about five hours each time.”
They disputed what they were charged, but the Bulls paid the hospital $ 500 a month for five years to settle only one of the baby’s invoices to maintain their credit. I agreed.
resolution: The family seemed to have no other place to turn, so they hired Resolve. This follows the path of the claims jungle in exchange for some of the money that saves clients.
Kirksey, a senior advocate at Resolve, founded in 2019 and with 16 employees, said it was “hard” to get Utah Valley to provide Signa with the information needed to pay for the hospital. It states. He said he would need to provide the hospital with a detailed list of steps to take and then follow up with multiple phone calls and emails a week.
After all, most of the errors that caused the Bulls nightmare were on the hospital side, Kirksey said. But instead of supplying what Cigna needed, Utah Valley chased the Bulls.
“The hospital was unable to repeatedly provide a detailed list of services and important clinical information, despite ongoing efforts to protect the information,” said Cigna spokeswoman Meaghan MacDonald.
“There were no errors on the part of the hospital,” said Utah Valley spokesman Daron Cowley. “Utah Valley Hospital properly billed for the services provided to the twins and provided Cigna with the requested information in a timely manner.”
The hospital did not charge the Bulls for any outstanding balance until nine months after the twins were born, and did not send the account to the collection until six months thereafter. “Plan,” he said.
Finally, the bill was resolved in the fall of 2021. The twins were one and a half years old. The Bulls paid the company about 10% -$ 8,000 to supplement Resolve to break the balance.
Although unrelated to medical costs, the fee was worth it to avoid much larger debt, said Greg Bull, who works in the finance department. “In the end, I was very relieved that it was a small amount,” he said. Still, many families would not have been able to afford it.
The point: Studies show that about one-fifth of emergency room visits are made at facilities that are outside the patient’s insurance network. Unsurprising legislation requires insurers to cover non-network emergency care at the same patient cost as in-network care. It is also prohibited for hospitals to charge patients additional fees.
However, if the insurance company denies care for an emergency, or does not obtain a document to prove it, the claim will be denied and the patient will remain on the hook.
“This is a coding problem we often see,” Kirksey says. In particular, “if the person literally didn’t check in from the emergency room,” Kirksey says.
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If this happens, insurance professionals will urge the patient to immediately appeal the decision to the insurance company. This is the process by which the law needs to be available. Unfortunately, it usually requires more phone calls, paperwork, and waiting. (If the appeal to the insurance company fails, the patient can consult an independent reviewer, such as the state insurance committee, the state attorney general’s office, or a help desk without surprises.)
Kevin Lucia, co-director of the Georgetown University Health Insurance Reform Center, said: ..
When the visit was confirmed to be an emergency, he said, protection from the no-surprise law would be clearly applied.
The no-surprise method is the first step in the right direction. However, it is clear that loopholes and minefields remain.
Stephanie O’Neill provided an audio portrait in this story.
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